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PubMed1991

Randomized study of preoperative versus postoperative radiation therapy in advanced head and neck carcinoma: long-term follow-up of RTOG study 73-03.

This is a report of a 10-year median follow-up of a randomized, prospective study investigating the optimal sequencing of radiation therapy (RT) in relation to surgery for operable advanced head and neck cancer. In May 1973, the Radiation Therapy Oncology Group (RTOG) began a Phase III study of preoperative radiation therapy (50.0 Gy) versus postoperative radiation therapy (60.0 Gy) for supraglottic larynx and hypopharynx primaries. Of 277 evaluable patients, duration of follow-up is 9-15 years, with 7.6% patients lost to follow-up before 7 years. Loco-regional control was significantly better for 141 postoperative radiation therapy patients than for 136 preoperative radiation therapy patients (p = 0.04), but absolute survival was not affected (p = 0.15). When the analysis was restricted to supraglottic larynx primaries (60 postoperative radiation therapy patients versus 58 preoperative radiation therapy patients), the difference for loco-regional control was highly significant (p = .007), but not for survival (p = 0.18). In considering only supraglottic larynx, 78% of loco-regional failures occurred in the first 2 years. Thirty-one percent (18/58) of preoperative patients failed locally within 2 years versus 18% (11/60) of postoperative patients. After 2 years, distant metastases and second primaries became the predominant failure pattern, especially in postoperative radiation therapy patients. This shift in the late failure pattern along with the increased number of unrelated deaths negated any advantage in absolute survival for postoperative radiation therapy patients. The rates of severe surgical and radiation therapy complications were similar between the two arms. Because of an increased incidence of late distant metastases and secondary primaries, additional therapeutic intervention is required beyond surgery and postoperative irradiation to impact significantly upon survival.

Adult↗

PubMed1992

Dose, time, and fraction size issues for late effects in head and neck cancers.

This paper contains a statistical analysis of the dose-time factors influencing late complications in 784 patients with squamous cell carcinomas of the pharynx or larynx treated with external beam irradiation only at the University of Florida. The patients include 560 who received continuous course once-a-day therapy, 116 who received twice-a-day treatment, and 108 who received a once-a-day split course regimen. Both 2+ and 3+ complications were considered. Fifty-six patients developed either of these complications. The factors included in the analysis were site and size of the primary, total dose, fraction size, and treatment time. The linear-quadratic model was used to incorporate fraction size into the analysis. Proportional hazards analysis, which models the time to occurrence of the late complication, was used to quantify the joint influence of the above patient and fractionation variables on the incidence of late effects. The occurrence of the late effects was heterogeneous, with only a weak relationship to the patient and fractionation variables. The influence of the size of the primary was significant, with larger primaries associated with higher complication rates independent of fractionation variables. For oropharynx primary sites there was no significant effect of the fractionation variables. For larynx and hypopharynx, excluding T1-T2 true vocal cord, there was a significant effect of total dose and fraction size. The alpha/beta ratio was estimated to be 7.8 Gy (95% confidence interval, 3.0, infinity). There was no significant effect of overall treatment time. The estimated 2+ complication rate at 1 year from 68 Gy given in 2 Gy fractions in 50 days is 0.1% for T 1-2 vocal cord, 4.1% for T1-T2 supraglottic larynx, 3.8% for T3 supraglottic larynx and vocal cord, 14.9% for T4 supraglottic larynx, 6.7% for T1-T2 tonsil and soft palate, 7.6% for T3-T4 tonsil and soft palate, 7.0% for T1-T2 pyriform sinus and pharyngeal wall, and 13.0% for T3-T4 pyriform sinus and pharyngeal wall.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

Elective neck dissection during salvage laryngectomy.

PURPOSE: To evaluate the rate of occult metastases detected with elective neck dissection during salvage laryngectomy for radiation failures. METHODS AND MATERIALS: Retrospective review of 63 patients failing radiation therapy treated with salvage surgery between 1970 and 1999. Charts were reviewed for tumor stage, neck treatment, complications, surgical time, and survival. Median follow-up for patients with glottic and supraglottic cancers was 7.8 and 4.5 years, respectively. RESULTS: Thirty-one of 41 glottic cancer patients received elective neck dissections. Three (10%) of 31 had occult metastases. Recurrent staged rT3 and greater tumors showed a 20% rate of occult metastases. No survival advantage was noted between patients treated with elective neck dissection and those followed expectantly (P = .87). Cartilage invasion and perineural invasion in the larynx were associated with a higher risk of occult metastases (P < .05). Ten of 22 supraglottic cancer patients received elective neck dissections. Two (20%) of 10 had occult metastases, and a statistically significant survival advantage was not noted (P = .49). CONCLUSIONS: We recommend bilateral neck dissection at the time of laryngectomy for recurrent staged rT3/4 tumors and all patients with recurrent supraglottic cancers because of the higher rate of occult metastases.

Adult↗

PubMed2006

Age related changes in the distribution of laryngeal glands in the human adult larynx.

OBJECTIVE: To understand the defense status of glandular tissue in the human adult larynx, we examined the glandular distribution, concentration and the ratio of the mucous glands in the subglottic and supraglottic larynx. METHODS: One-hundred and seven adult larynges were examined. The area of the mucosa and glands were measured using an image analyzing system. The correlations of the concentration as well as the ratio of the mucous glands with age were analyzed. RESULTS: The ratio of the areas occupied by the glandular acini of the subglottis was almost equal to that of infants as we reported earlier. The concentration of the laryngeal glands decreased in higher-aged adults at the level of the supraglottis, but not at the level of the subglottis. CONCLUSIONS: In comparison to infants, the ratio of laryngeal glands of the human subglottic larynx is rather constant in human adults. However, the supraglottic larynx seems to be influenced by increasing age. The changes deserved in the laryngeal glands predominantly occur in the supraglottic larynx.

Adult↗

PubMed1985

Management of giant cystic hygromas in infants.

Giant cystic lymphangioma is a rare lesion that presents major therapeutic challenges. Four infants presented in the first weeks of life with diffuse cysts in the neck. The tongue was involved in three, the mediastinum in one, and the pharynx and supraglottic larynx in two. These lesions are characterized by hundreds of cysts that infiltrate in and around muscles, nerves, and vessels. Complete excision is not possible without damaging the normal structures. All four infants initially had partial removal with unroofing and drainage of the remaining cysts and temporary tracheostomy to protect the airway. One infant died from a thrombosed sagittal sinus. She had severe venous congestion of the head and neck postoperatively which may have been caused by an overzealous attempt to remove all of the cysts. The other three have required nine additional operations for removal of recurrent neck cysts (one operation), removal of mediastinal cysts (one operation), partial glossectomy (three operations), and laser excision of lymphangiomas of the pharynx and supraglottic larynx (four operations). Two patients have required partial glossectomy which should be performed early to protect the airway, to allow normal speech development, and to prevent malocclusion and prognathism from constant pressure of the tongue against the teeth. Removal of wedges of tissue from each side and from the center of the dorsum of the tongue reduces bulk with minimal risk to the lingual arteries and nerves. Recurrent tongue enlargement is common and can be treated by repeated partial glossectomy. Lymphangiomatosis of the pharynx and supraglottic larynx is difficult to treat. The carbon dioxide laser allows very precise excision of individual cysts with minimal drainage to adjacent mucosa, but in our limited experience it has not prevented recurrence. Despite the extensive nature of these lesions, the impossibility of complete excision, and the need for multiple operations, the long-term results in the three surviving patients have been satisfactory. Asymmetry of the neck and face due to lymphedema tends to improve with time. All three children have an acceptable appearance and normal speech for their ages.

Female↗

PubMed1998

The prognostic significance of tracheostomy in carcinoma of the larynx treated with radiotherapy and surgery for salvage.

PURPOSE: To determine retrospectively the prognostic significance of airway compromise necessitating tracheostomy in carcinoma of the larynx managed with radical radiotherapy and surgery for salvage (RRSS). METHODS AND MATERIALS: The charts of 270 patients managed with RRSS at the Toronto-Sunnybrook Regional Cancer Centre between June 1980 and December 1990 were reviewed. Airway compromise necessitating tracheostomy was documented in 26 patients prior to radiotherapy and 3 patients during radiotherapy. Of 29, 27 had T3T4 primaries. Patients have been followed for a median of 5 years. RESULTS: Patients managed without tracheostomy had a 2-year disease-free survival of 74% compared to 41% for those managed with tracheostomy. The adverse impact of airway compromise was more marked in patients with glottic primaries (78% vs. 32%, p = 0.0001) than those with supraglottic primaries (64% vs. 47%, p = 0.18). Tracheostomy was identified in univariate analysis, but not in multivariate analysis, as having a statistically significant impact on local control and local-regional control. Radiotherapy controlled disease above the clavicles in 185 of 267 (69%) evaluable patients. 83% of isolated local-regional failures underwent salvage surgery. Among those managed without tracheostomy, ultimate local-regional control (LRC) was achieved in 161 (94%) of 172 glottic primaries and 54 (81%) of 67 supraglottic primaries. Among those managed with tracheostomy, ultimate LRC was achieved in 9 (69%) of 13 glottic primaries and 12 (80%) of 15 supraglottic primaries. In a subset analysis of 76 patients with T3T4 primaries, there was no statistically significant difference in larynx preservation, disease-free survival, or cause-specific survival between those managed with and without tracheostomy. CONCLUSION: Airway compromise necessitating tracheostomy is an adverse prognostic factor in patients with carcinoma of the larynx. However, larynx preservation is possible in over 40% of those undergoing tracheostomy and radiotherapy with no compromise of cause-specific survival. The need for pretreatment tracheostomy should not rule out the possibility of RRSS.

Adult↗

PubMed1985

A histopathological study of carcinoma of the larynx.

Fifty-one laryngectomy specimens were histopathologically studied in serial sections. The incidence of thyroid cartilage invasion was 10% in supraglottic, 48% in glottic, and 67% in subglottic carcinomas. The incidence of cricoid cartilage invasion was 0% in supraglottic, 22% in glottic, and 33% in subglottic carcinomas. The sites of cartilage invasion were the anterior commissure portion and an ossified lower portion of the thyroid cartilage, and an ossified upper portion of the cricoid cartilage. Fixation of the vocal fold in glottic carcinoma was accounted for by carcinomatous invasion into three-fourths or more of the thyroarytenoid muscle. Impairment of the vocal fold movement was accounted for by carcinomatous invasion into three-fourths or less of the thyroarytenoid muscle. Fixation of the vocal fold in supraglottic carcinomas was accounted for by a massive carcinomatous invasion around the upper aspect of the arytenoid cartilage.

Arytenoid Cartilage↗

PubMed1989

Primary management of limited laryngeal cancer by radiotherapy and surgical salvage: results of 164 cases treated in a district hospital.

A total of 164 patients with limited laryngeal cancer (all sites, stages T1T2T3, N0N1) were treated between 1966 and 1979 at the Derbyshire Royal Infirmary by a policy of radical radiation therapy and surgical salvage. Of 122 cases of glottic cancer, 32 recurred of which 12 were successfully salvaged by laryngectomy. The corrected actuarial survival at 6 years was T1 95.1%, T2 83.0% and T3 31.3%. Of 38 cases of supraglottic cancer, 18 recurred but none was salvaged. The corresponding survival rates were T1 84.6% and T2 36.4%. A number of factors were analysed by a multivariate stepwise regression method to assess their impact upon radiation failure. These were: tumour status, nodal disease, the presence of symptoms other than hoarseness, histological grade, age, length of history and dose (TDF). Significant determinants in glottic cancer were tumour stage (P less than 0.0005), nodal disease (P less than 0.05) and presence of symptoms (P less than 0.05). In supraglottic cancer dose (P less than 0.001) and severity of symptoms (P less than 0.005) were predictive. It is concluded that this policy was effective in the management of T1 and T2 glottic cases and that T1 supraglottic cases responded well if an adequate radiation dose was delivered. The more advanced stages in both sites, however, did not fare as well, especially if initially node positive and in the presence of severe pretreatment symptoms. Surgical salvage had little impact on overall survival in this group.

Adult↗

PubMed2002

Radioactive gold grain implants in recurrent and locally advanced head-and-neck cancers.

PURPOSE: The radioactive gold grain applicator and seeds offer the flexibility necessary for effective use in the treatment of difficult sites of head-and-neck cancers. This study reviews our experience with gold grain (198Au) implants in locally advanced head-and-neck cancer to demonstrate their efficacy and feasibility. METHODS AND MATERIALS: This study reviewed the charts of 94 patients who were treated with gold grain implants (1970-1995) and who were treated with radioactive 198Au implants. Thirty-seven of the subjects had implants located in the head-and-neck region, and these form the basis for this report. Of these, eight of the cases were located in the supraglottic larynx, five in the nasopharynx, four in the retromolar trigone, two in the oral cavity, four in the base of the tongue, four in the maxillary antrum, four in the palate, two in metastatic cervical lymph nodes (of unknown primary tumor), two in the tonsillar fossa, one in the pyriform fossa, and one in the posterior pharyngeal wall. Twenty-eight were recurrent cases after prior surgeries and radiation. Six were residual locally advanced cases, and 3 patients had their implants for a second primary tumor in an area that had been irradiated before. The gold grains were inserted with a Royal Marsden gun and 198Au, 130-180 MBq per seed. The median number of seeds implanted was 34. The total radiation dose, delivered at a margin of 0.5 cm around the target volume, ranged from 40 to 120 Gy, with a median of 80 Gy. RESULTS: Complete local control was achieved in 33% and was contingent on two factors: (1) the size of the lesion implanted and (2) the histology and possible primary tumor site. In 19 tumors with a diameter greater than 2.5 cm, only 2 (11%) had complete tumor control. Conversely, 9 of 14 patients (64%) who had lesions smaller than 2.5 cm experienced successful local control (p = 0.002). Palatal-adenoid-cystic tumors had an average progression-free survival of 52 months, compared with 13, 9, and 4 months, respectively, in nasopharyngeal, oropharyngeal, and supraglottic squamous cell carcinoma. Palliation was successfully accomplished in 76% of the cases. Cessation of bleeding occurred in 50% of the subjects, pain control was achieved in 88%, and 60% experienced relief of dysphagia. CONCLUSIONS: Gold grain implants have a role in the palliation of recurrent head-and-neck tumors, particularly for sites difficult to reach via other techniques, such as the supraglottic larynx, base of the tongue, hypopharynx, and the nasopharynx. Local control is best achieved in lesions less than 2.5 cm in dimension and is most successful in slow-growing tumors.

Aged↗

PubMed1976

Cancer of the larynx in Hull and the surrounding area of East Yorkshire.

A study of all patients with cancer of the larynx in a population of 449,430 over ten years shows that supraglottic and epilaryngeal cancer has an almost equal incidence to glottic cancer. There is a relationship between urbanization and the incidence of cancer of the larynx, and between cancer of the larynx and bronchogenic carcinoma. A policy of radiotherapy with surgery held in reserve for supraglottic and epilaryngeal cancer failed at a general hospital, for reasons that have been discussed. Primary surgery is required for most cases of supraglottic and epilaryngeal cancer. Radiotherapy with surgery held in reserve is the most appropriate treatment for the great majority of glottic cancers. When radiotherapy failed to cure the disease palliation was achieved in only a small minority of the cases.

Adult↗

PubMed1997

Squamous cell carcinomas of the head and neck: descriptive analysis of 1293 cases.

Medical reports of 1293 patients with squamous cell carcinoma (SCC) of the head and neck were retrospectively evaluated. The patients were classified according to their age, sex, primary tumour localization and tumoral stage. There were 1181 males (91.3 per cent) and 112 females (8.7 per cent), with a male to female ratio of 10.5:1. The peak incidences for all primary tumour localizations were observed in the fifth decade. Most common primary tumour localizations were the larynx (71.1 per cent), the nasopharynx (10.1 per cent) and the oral cavity (8.8 per cent). Of all patients in whom staging was complete, 43.1 per cent presented at early and 56.9 per cent at advanced stages. The proportion of patients presenting with metastatic neck nodes was 34.4 per cent and the incidence of metastatic neck nodes increased with increasing T stage. The supraglottic region was the most common primary site among all laryngeal SCC, with a supraglottic to glottic SCC ratio of 1.5:1. Glottic SCC presented at earlier stages compared to supraglottic SCC. The incidence of nodal metastases increased with increasing T stage for SCC of the larynx, the oral cavity and the oropharynx.

Adult↗

PubMed2006

The immunohistochemical expression of p21WAF1/Cip1 and Proliferating cell nuclear antigen in laryngeal squamous cell carcinomas.

The purpose of this study was to assess the significance of the expression of p21WAF1/Cip1 and proliferating cell nuclear antigen (PCNA) in human laryngeal squamous cell carcinomas. Forty-eight patients (25 supraglottic, 23 glottic) who had undergone operations between 1998 and 2003 were included in this study. The Envision immunohistochemistry method was utilized to stain these tissue specimens. The results showed that the immunostaining of p21WAF1/Cip1 do not show any correlation with differentiation, N stage, metastasis, survival, recurrence or the laryngeal site of involvement. A significant inverse correlation was detected between p21WAF1/Cip1 and the T stage. In contrast, the percentage of PCNA labelled cells showed a significant correlation with the T stage, but not with other clinicopathological parameters. There were differences in the expression of p21WAF1/Cip1 and PCNA between the supraglottic and the glottic carcinomas. In conclusion, our findings suggest that p21WAF1/Cip1 and PCNA may play an important role in the progression of carcinoma of the supraglottic larynx.

Adult↗

PubMed2005

The laryngeal tube for difficult airway management: a prospective investigation in patients with pharyngeal and laryngeal tumours.

BACKGROUND AND OBJECTIVE: Since the introduction of the laryngeal mask into clinical practice, various additional supraglottic ventilatory devices have been developed. Although it has been demonstrated that the laryngeal tube is an effective airway device during positive pressure ventilation no clinical study has been performed thus far regarding its use in patients with predicted ventilation and intubation difficulties. METHODS: The aim of this study was to prospectively evaluate the use of the laryngeal tube for temporary oxygenation and ventilation in adult patients with supraglottic airway tumours scheduled to undergo a pharyngeal-laryngeal oesophagoscopy and bronchoscopy under general anaesthesia. In addition to our standard airway management with face mask ventilation and rigid bronchoscopy, all patients were temporarily ventilated with an laryngeal tube. Also, in patients requiring laryngeal biopsies, endotracheal intubation was performed with a 6.0 mm microlaryngeal tracheal tube. Minute ventilation volumes, tidal volumes, ventilation pressures, end-expiratory CO2 concentration, oxygen saturation and arterial blood gas samples were measured. RESULTS: From 54 enrolled patients only patients with relevant tumour masses were evaluated (n = 23). Mask ventilation was performed without difficulty in 15 of 23 patients. Mechanical ventilation with the laryngeal tube was possible in 22 of 23 patients with an audible leak present in three. Conventional endotracheal intubation was successfully performed in 19 of 23 patients. During face mask ventilation, minute volume, tidal volume, ventilation pressure, end-tidal CO2, oxygen saturation and arterial PO2 were significantly lower and PCO2 significantly higher (P < 0.05, paired t-test). No statistically significant differences were noted between the laryngeal tube and the microlaryngeal tracheal tube. CONCLUSIONS: The possibility of difficult ventilation and intubation must always be considered, in patients with supraglottic airway tumours. In these cases, the laryngeal tube can be considered for routine airway management and may be useful in the 'cannot-intubate' situation although difficulties should be anticipated in patients with previous irradiation, specifically of the throat area.

Adult↗

PubMed1994

[Detection of human papillomavirus DNA in formalin fixed invasive squamous cell carcinoma of the larynx with polymerase chain reaction (PCR)].

Approximately 67 different subtypes of HPVs have now been described. Regularly most of the cervical cancers are positive for HPV 16/18. Current research also indicates that HPVs may be involved in the development of benign tumours and also squamous cell cancers of head and neck. Studies establishing the presence of different HPV subtypes in oral cancers and precancers suggest the possibility of the virus as etiological factor in oral carcinogenesis too. In this study the prevalence of HPV 6/11, 16 and 18 infection and other exogenous risk factors like nicotine and alcohol in laryngeal cancers were studied. A total of 100 formalin-fixed and paraffin-embedded cancers, 41 glottic and 59 supraglottic, in patients aged 58 years, were detected by use of the E6 specific PCR for HPV DNA. Significantly more glottic cancers, 26 of 41 (63.4%), were positive for the investigated HPV's. HPV 16 was found in all positive cancers. This predominance of HPV 16 was also present in the supraglottic carcinomas, but only 10.2% (6 of 59) of the these groups were HPV positive. In both groups the patients with HPV 16 and/or 18 positive cancers, the exogenous risk factor was higher than with in HPV 16/18 negative tumours. Following infection, the virus either remains dormant or else undergoes active replication resulting in the synthesis of infectious virus. The integration of virus DNA into the host cell DNA may be the result of action of nicotine and/or alcohol. The integration event is the key of the carcinogenesis. The level of the risk factor in the patients with supraglottic tumours was significantly higher.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1997

[Parastomal tumors after laryngectomy: etiology and therapy].

BACKGROUND: Parastomal neoplasm after total laryngectomy for laryngeal carcinoma represents an extremely serious complication and one of the most formidable therapeutic problems encountered by the head and neck surgeon. Studies about the etiology of parastomal neoplasm have been controversial. The factors most strongly implicated in parastomal neoplasm have been recurrence spawned by metastases to deep cervical lymph nodes, undetected neoplasm at the margin of the laryngectomy resection, neoplastic cell implantation by pre-operative tracheotomy, and the development of an additional primary. PATIENTS: To clarify the controversial aspects of parastomal neoplasm etiology, a systematic analysis of parastomal neoplasm after laryngectomy was performed using data from 10 patients who developed parastomal neoplasm. RESULTS: Parastomal neoplasm occurred in 7.9%. The tumor site of the primary laryngeal carcinoma was found in 9/10 cases in the subglottic, supraglottic, or transglottic area. These tumor sites correlate with areas of a lymphatic vessel concentration and an increase of intralaryngeal lymphatic drainage. In average the parastomal neoplasms appear 10.3 months after the laryngectomy. Therapy was unsuccessful in spite of extensive surgical interventions. CONCLUSIONS: If the laryngeal carcinoma was resected with margins of healthy tissue, lymphatic metastasis to the pretracheal and paratracheal cervical lymph nodes is the probable cause of parastomal neoplasm. This could be the consequence of the continuous lymphatic drainage between the supraglottic and subglottic area with a midline crossing and an lymphatic outlet to the pretracheal and paratracheal cervical lymph nodes. The cervical metastasis formation cannot be detected due to the limitations in the assessment of small lymph nodes and the inability to ascertain with confidence the presence or absence of metastasis in any one lymph node in ultrasonography, computed tomography, and magnetic resonance imaging and due to the limitations in the removal of lymph nodes in the pretracheal and paratracheal area by means of a functional or radical neck dissection. The method of treatment should be in cases of a subglottic or a supraglottic laryngeal carcinoma an ipsilateral and contralateral pretracheal and paratracheal lymph node removal in combination with the laryngectomy.

Aged↗

PubMed2000

Symptoms of laryngeal carcinoma and their prognostic significance.

Symptoms of 301 patients with laryngeal squamous cell carcinoma were evaluated. Tumour site affected the symptom profile significantly. Hoarseness was more common among patients with glottic and subglottic tumours, but was also the leading symptom in supraglottic patients. Other symptoms were mainly associated with supraglottic tumours and more advanced glottic lesions. There was a positive correlation between the number of symptoms and stage, regardless of tumour site. Patients with a supraglottic tumour had significantly more symptoms (median 2) than those with a glottic lesion (median 1). The median duration of the symptoms was significantly longer in stages III-IV (4.7 months) than in stages I-II (3.8 months). In the multivariate analysis, tumour stage was the only variable showing prognostic significance.

Adult↗

PubMed2000

Is the subsite distribution of laryngeal cancer related to smoking habits?

In Finland traditionally as many as two-thirds of laryngeal cancers have been considered to be supraglottic, while in other countries the majority are glottic. The Finnish observation is based on clinical series diagnosed and treated mainly before the 1960s. The aim of our study was to evaluate the present situation. This study consisted of 279 patients treated in Eastern Finland between 1975 and 1994 and included 145 (52%) glottic, 124 (44%) supraglottic and 10 (4%) subglottic tumours in 260 (93%) men and 19 (7%) women. During this study period, the proportion of glottic tumours remained stable in men but increased in women. The change in smoking habits seems to be the most important reason for the shift from supraglottic to glottic tumours.

Adult↗

PubMedDate not supplied

The EasyTube for airway management in emergencies.

BACKGROUND: The EasyTube (EzT) is a new sterile, disposable airway device approved by the European Union in February 2003 and by the U.S. Food and Drug Administration in January 2005. The two-lumen design of the EzT enables it to be used as an endotracheal tube or as a supraglottic emergency airway. OBJECTIVE: To report the preliminary experiences with the EzT airway device in prehospital and in-hospital emergency airway management procedures. METHODS: All airway management procedures involving the EzT were recorded for a period of 18 months. RESULTS: The EzT was successfully used to intubate 15 patients with unanticipated airway difficulties during either anesthesia induction or prehospital airway management. In all patients, the EzT was positioned successfully in the first attempt, within a median time of 31 seconds until start of ventilation. Effective supraglottic ventilation and oxygenation was achieved within 25 to 40 seconds. In three patients, the EzT needed one additional repositioning maneuver. On removal of the EzT, no blood was observed on the surface of the device, as a sign of absence of potential mucosal lesion. No injuries were observed in the mouth, pharynx, or esophagus. CONCLUSIONS: The first experiences with the use of the EzT are promising. In emergency airway management procedures presenting problems, the device successfully established sufficient ventilation and oxygenation. Further studies are needed to compare its value with those of other supraglottic devices.

Adult↗